Emerging AHP Strategies for Recruitment Maria E. Alvarez, MPA CDC/NCHSTP/DHAP/PPB Public Health Advisor Duty Point: NYC mma8@cdc.gov 212-268-6221

Recruitment An activity or set of activities intended to bring persons at high risk for being exposed to or for transmitting HIV into interventions to promote the adoption and maintenance of risk-reduction behaviors A critical element to the success of any intervention

Recruitment Strategies to engage members of a target audience/population into HIV prevention interventions, care, and services Promotion of awareness of HIV programs Outreach, referral network, social marketing, community-level interventions and individual-level interventions

Fundamental Strategies for Recruitment Outreach Intensive/Enhanced/Targeted In-reach Referral Network Social Marketing Community Level Interventions (CLI) Individual Level Interventions (ILI)

Outreach Working in the community rather than waiting for the community to come to the agency or organization A set of activities conducted in the community to provide HIV prevention information communicate the benefits of early knowledge of one's serostatus conduct risk-reduction interventions promote agency programs refer or link persons at high risk to prevention interventions and services

Outreach Conducted by peers, health educators, or outreach workers on the streets and face-to-face Conducted in specific venues where persons at high risk congregate, such as neighborhood streets, parks, bars, bathhouses, adult book stores, shooting galleries, or crack houses

Outreach (Intensive or Enhanced ) Implements a “higher threshold outreach” with specific objectives and methods for engaging high-risk populations and or sub-populations into care and treatment Uses non-traditional venues and hours Provides a direct connection to needed and or wanted services as well as consistent support Encourages recruitment into prevention interventions, care, and services (using highly trained and experienced peers) Enhanced Outreach Workers are trained and cross-trained in a variety of topics, harm reduction, behavior change and motivational interviewing. They provided consumers with a continum of services that may include HIV counseling and testing, and referring individualss to prevention case management, supportive and health care services.

Outreach (Targeted) Designed to reach a specific population or sub-population of persons, as opposed to “general outreach,” which may involve mass mailings and tabling of information (e.g., health fairs) and is not targeted to any particular audience

In-reach Educational activity that provides HIV prevention information and promotes HIV program services to its own staff and to persons participating in services and programs Conducted in the waiting areas or during an intake process for programs serving high-risk persons

Referral Networks Are an important strategy for recruiting persons at high risk into HIV intervention activities Identifies other providers of services to the same population Develops reciprocal agreements between service providers

Referral Networks Bi-directional (most often) Formal mechanism for client referrals and service provision, delineating responsibilities Broader HIV prevention services, including Clinics Substance abuse treatment facilities Homeless shelters Domestic violence programs Health department based STD, TB, or hepatitis related services

Social Marketing Planning and implementation of programs designed to bring about social change using concepts from commercial marketing Social Marketing includes the use of advertising, billboards media campaigns, public service announcements Web site development brochures, palm cards

Community Level Interventions (CLI) Seek to improve the risk conditions and behaviors in a community through a focus on the community as a whole Work to alter social norms, policies, or characteristics of the social environment Implement community-wide events, policy interventions, and structural interventions

CLI and Activities Outreach to promote awareness of program services (e.g., agency meetings, conferences, health fairs) Health communication/public information (e.g., presentations at community forums, use of print/electronic media, telephone hotline, information clearinghouse, resource library) Social marketing campaigns Community mobilization

Individual Level Interventions (ILI) Assist clients make plans for individual behavior change and ongoing behavioral appraisals Facilitate linkages to services in both clinic and community settings in support of behaviors and practices that prevent transmission of HIV Help clients make plans to obtain needed services Provide health education/risk reduction counseling to one person at a time

ILI Activities Client intake Assessment of clients’ strengths and developmental assets as well as risks for HIV infection or transmission Comprehensive HIV prevention education and counseling, e.g., abstinence, risk reduction, interpersonal/ negotiation skills development Prevention Case Management (PCM)

ILI Activities HIV Counseling and Testing (on-site or through a direct referral agreement) Partner notification assistance counseling and communication skills-building for HIV positive clients Referral and follow-up to needed services (e.g., primary health care, STD screening/tx, pregnancy testing, substance use, mental health, housing, education, employment, legal services)

ILI Activities Crisis interventions Outreach to provide HIV prevention/risk- reduction education Distribution of HIV prevention/risk- reduction supplies and materials (e.g., male and female condoms, dental dams, bleach kits, print/video/audio educational materials)

In Conclusion…. Emerging AHP Strategies Depends gravely on RECRUITMENT And remains key in effectively working with the three primary areas of HIV prevention that CDC is emphasizing: Early detection of persons who are HIV positive and referral to care services Prevention interventions with persons living with HIV Prevention with persons who are at high risk for HIV infection

Recruitment Is Critical to Successful HIV Prevention